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research-article2013

AOPXXX10.1177/1060028013513147Annals of PharmacotherapyMcBride

Letter Annals of Pharmacotherapy 2014, Vol. 48(4) 552­–553 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1060028013513147 aop.sagepub.com

Criterion for Board Certification Needs Revision

TO THE EDITOR: New graduates should not be allowed to sit for the Board Certification in Pharmacotherapy (BCPS) without residency training. In my professional practice, I am noting 2 disturbing trends regarding BCPS. First, professionals are using certification inappropriately as a replacement for postgraduate residency or fellowship education. Second, employers are starting to require board certification as a condition of employment. Based on recent survey data, approximately 70% of my colleagues in pharmacy academia who did not renew their BCPS perceive that there is no perceived benefit to BCPS apart from personal satisfaction.1 Without critical revisions to the eligibility criteria, the BCPS, could lose additional credibility in the pharmacy community, and thus risks being perceived as a waste of time and money by a greater proportion of pharmacists. Prerequisites for BCPS certification do not appear to have been revised since the first certification test was administered 2 decades ago.2 As it stands now, the Board of Pharmacy Specialties recognizes that 3 years of clinical experience is analogous to a year of formal residency or fellowship education. Pharmacy students with whom I have worked claim they can work for 3 years and take a standardized test to make their experience equivalent to a residency (or fellowship). In my opinion, this devalues the importance of formalized postgraduate education. Going forward, a minimum of 2 years of residency and/or fellowship training should be required of all new graduates (graduating in 2018 and beyond) as a prerequisite to the BCPS examination. This is the standard practice for any physician who sits for Board Certification in Internal Medicine. In my trained subspecialty, Clinical Pharmacology, a National Institutes of Health–funded fellowship in Clinical Pharmacology is a prerequisite to Board Certification in Clinical Pharmacology. I do not believe the BCPS should be any different in its approach to certification. Moreover, and in contrast to Board Certification processes in Internal Medicine, Cardiology, and Clinical Pharmacology, the BCPS has never been shown to improve patient care. Although the Board of Pharmaceutical Specialties lists such outcome studies in their longitudinal plan, no protocols have been publicly proposed for comment. Accordingly, there are also no data showing that Board Certification reduces readmission rates, a key barometer of Medicare reimbursement to hospitals. There are data, however, that residency programs, including those with formal education on medication safety do reduce medication errors.3,4 Considering this paucity of similar data for

the BCPS, it is bewildering that some employing organizations require BCPS as a condition of employment. The amount of money employers spend on the BCPS and requisite maintenance for employees is simply a money grab for the 2 organizations that provide BCPS eligible continuing education. In my opinion, these funds could better be used in an area that does improve patient outcomes: more residencytrained pharmacists!5-9 In our profession, we would not likely treat a patient with a drug that increases cost and is not proven to improve outcomes. So, why is our profession, in some instances, requiring the BCPS as a condition of employment when it is not yet proven to improve outcomes? In my opinion, pushing the BCPS without evidence of effectiveness or lack thereof is ridiculous. To rectify these issues, the Board of Pharmaceutical Specialties should 1. Act quickly on its longitudinal goal to undertake independently analyzed research to demonstrate the value of the BCPS. If the studies show a benefit, then certification should be incorporated into clinical laddering. If not, the BCPS should not be likely to suffer any harm to its current reputation. 2. Mandate that, anyone who received their first pharmacist license in the United States of America after July 1, 2018 be required to have completed an accredited PGY-1 residency or advanced residency/ fellowship training as the sole option for Board Certification in Pharmacotherapy. Brian F. McBride, PharmD Roosevelt University, Chicago, Illinois, USA [email protected] Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

References 1. Toussaint KA, Watson K, Marrs JC, Sturpe DA, Anderson SL, Haines ST. Prevalence of and factors that influence board

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McBride certification among pharmacy practice faculty at United States colleges and schools of pharmacy. Pharmacotherapy. 2013;33:105-111. 2. Board of Pharmacy Specialties. http://www.bpsweb.org/pdfs/ CandidatesGuide.pdf. Accessed April 19, 2013. 3. De Oliveira GS Jr, Rahmani R, Fitzgerald PC, Chang R, McCarthy RJ. The association between frequency of selfreported medical errors and anesthesia trainee supervision: a survey of United States anesthesiology residents-in-training. Anesth Analg. 2013;116:892-897. 4. Foster ME, Lighter DE, Godambe AV, Edgerson B, Bradley R, Godambe S. Effect of a resident physician educational program on pediatric emergency department pharmacy interventions and medication errors. J Pediatr Pharmacol Ther. 2013;18:53-62. 5. Hadi MA, Alldred DP, Closs SJ, Briggs M. Effectiveness of pharmacist-led medication reviews in improving patient outcomes in chronic pain: a systematic review protocol. Can Pharm J (Ott). 2012;145:264.e1-266.e1.

6. Gastelurrutia P, Benrimoj SI, Espejo J, Tuneu L, Mangues MA, Bayes-Genis A. Negative clinical outcomes associated with drug-related problems in heart failure (HF) outpatients: impact of a pharmacist in a multidisciplinary HF clinic. J Card Fail. 2011;17:217-223. 7. Acquisto NM, Hays DP, Fairbanks RJ, et al. The outcomes of emergency pharmacist participation during acute myocardial infarction. J Emerg Med. 2012;42:371-378. 8. MacLaren R, Bond CA. Effects of pharmacist participation in intensive care units on clinical and economic outcomes of critically ill patients with thromboembolic or infarctionrelated events. Pharmacotherapy. 2009;29:761-768. 9. Bond CA, Raehl CL. Clinical and economic outcomes of pharmacist-managed antiepileptic drug therapy. Pharmacotherapy. 2006;26:1369-1378.

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Criterion for board certification needs revision.

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